Abstract
Thoracic endovascular aortic repair (TEVAR) has quickly become the
mainstay of treatment for acute aortic dissection, in particular cases
of acute complicated Stanford Type B dissection (co-TBAD). Necessarily,
TEVAR carries with it the risk of postoperative complications, including
stroke and renal failure. As a result, the management of patients with
uncomplicated type B aortic dissection (un-TBAD), which is generally
accepted as being less severe, are safely managed via optimal medical
therapy (OMT) alone. However, despite OMT, patients with un-TBAD are at
substantial risk of severe disease progression requiring delayed
intervention. The cost-benefit ratio associated with TEVAR for un-TBAD
is therefore of key interest. Howard and colleagues produced a
fascinating systematic review and meta-analysis investigating the
clinical outcomes of TEVAR for complicated and uncomplicated TBAD. Their
data suggests that there is no significant difference in in-hospital
mortality or 5-year survival between TEVAR for un-TBAD and co-TBAD,
although the 30-day mortality rate appeared to be higher in the co-TBAD
cohort. Patients with co-TBAD appeared to also be at a higher risk of
postoperative stroke and TEVAR endoleak, while un-TBAD patients were at
a higher risk of postoperative renal failure. Further prospective
research into these relationships are recommended to fully elucidate the
comparative efficacies of TEVAR for un-TBAD and co-TBAD.